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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate gland (prostate) in men, which has a negative effect on both sexual function and the urinary process. Pain in the perineum, groin, lower back and pelvic area, urodynamic disorders (urine outflow) may indicate the presence of prostatitis. Prostatitis that is not treated in time can lead to male infertility and prostate cancer.

This is one of the most common male diseases, requiring careful attention and efficient systemic treatment. This approach to solving the problem of prostatitis you will find in the urology department of a professional clinic. Highly qualified urologists-andrologists have been successfully treating acute and chronic prostatitis for many years. Complex therapy, a caring attitude and an individual approach to each case inevitably lead patients to stable long-term recovery and remission.

Prevalence

Prostatitis ranks 5th among the top 20 urological diagnoses. It is believed that at the age of 30, 30% of the male population suffers from prostatitis, at 40 years - 40%, and after 50 years, almost all men one way or another bear the burden of this disease. And if up to 35 years mostly infectious prostatitis is recorded, then at a more mature age the non-infectious form occurs, and in general it is diagnosed several times more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate gland

The prostate gland (prostate) is located in the lower front of the pelvis below the bladder. It consists of glandular and smooth muscle tissue, surrounded by a fibrous capsule. The urethra passes through the body of the prostate from the bladder, where the ejaculatory duct opens.

The prostate is a hormone-dependent organ. It is formed and functions under the influence of male hormones - androgens. Testosterone plays an important role in this process.

The prostate gland is associated with the seminal tubercle, which acts as a valve for the ejaculatory duct. As part of the male reproductive system, the prostate affects erection, ejaculation, and orgasm. The nerve responsible for erection passes through the gland. In the chronic course of this disease, they are involved in the inflammatory process, and erectile dysfunction develops.

The prostate produces a secret that is part of semen. It creates favorable conditions for the activity of spermatozoa. Therefore, with chronic dysfunction of the gland, male infertility can be observed.

Pathogenesis

There are two main reasons for the development of prostatitis:

  • stagnation of prostate secretion against the background of impaired blood circulation and lymph outflow in the gland itself and neighboring organs;
  • pathogenic and conditional microflora.

Acute prostatitis is usually associated with an infection of the prostate tissue. But, as a rule, both factors are interconnected and together create a vicious circle that makes it difficult to treat prostatitis.

An inflamed prostate becomes painful. Pain can be felt in the perineum, groin, pelvis, lower back. It increases sharply on palpation during digital examination of the rectum or defecation.

The prostate increases in size, narrowing the urethra. Therefore, the outflow of urine from the bladder becomes difficult. The flow of urine becomes weak. The patient needs to tense the abdominal muscles in order for the act of urinating to occur. In acute cases, sometimes there is urinary tract obstruction, and acute urinary retention.

Inflammation leads to a violation of the outflow of prostate juice and its stagnation. The resulting edema interferes with cellular metabolism and respiration in the gland. This creates the conditions for the chronology of the process. With protracted prostatitis, neighboring organs can also be inflamed: seminal tubercles, Cooper's glands, seminal vesicles. The chronic form of this disease is associated with the risk of developing male infertility, adenoma and prostate cancer.

In recent years, it has been found that in 70-80% of cases, prostatitis occurs due to the stagnant process in the gland. Venous disorders are less common, but they also cause prostatitis, especially if accompanied by hemorrhoids and varicocele on the left side (enlargement of testicular veins).

Classification

The American National Institutes of Health identify 4 categories of prostatitis:

  • Acute prostatitis (Category I)
  • Chronic bacterial prostatitis (Category II)
  • Chronic Prostatitis / Chronic Pelvic Pain Syndrome (Category III)
  • Asymptomatic chronic prostatitis (Category IV)

Due to the occurrence of prostatitis is divided into two types:

  • not contagious
  • Contagious

The inflammatory process can develop quickly, accompanied by obvious symptoms (acute stage), or slowly with increasing symptoms extinguished.

Prostatitis is not contagiousin most cases, it is associated with stagnation of prostate gland secretions and impaired blood circulation and lymph flow in the gland itself and nearby organs.

Infectious prostatitisdevelops due to the penetration of pathogenic or conditionally pathogenic microflora into the tissue of the prostate gland: bacteria, viruses, fungi. There are different ways for infection to enter the prostate:

  • Urinogenic (ascending): the entrance is the urethra. It should be noted that the infection can also get downstream, for example, with purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenic: infection from neighboring pelvic organs can enter the prostate through lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as from infected hemorrhoidal veins.
  • Hematogenous (through the blood): caused by the presence in the body of a focus of chronic infection (tonsillitis, dental caries) or complications of an acute infection (flu, acute respiratory infection, tonsillitis, etc. ).

The most common causative agents of prostatitis are:

  • bacteria: E. coli, Proteus, gardnerella (gram-negative); staphylococci, streptococci (gram-positive);
  • viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • mycoplasma;
  • chlamydia;
  • certain flora (gonococcus, Trichomonas, Mycobacterium tuberculosis).

According to the nature of the course, prostatitis occurs:

  • spicy
  • Chronicle

Acute prostatitisusually occurs under the influence of pathogenic microflora (conditional pathogens) in the presence of predisposing factors. It has a fast course and clear symptoms. If it is not cured in time, the purulent process can develop, which leads to melting of the tissue of the prostate gland. With improper treatment, acute prostatitis often becomes chronic.

Chronic prostatitishave a milder course, erased symptoms. However, it may worsen over time, and then the symptoms will correspond to an acute process. At the same time, complete remission between exacerbations does not always occur, and the patient may always feel uncomfortable. Chronic prostatitis can cause impotence, male infertility, adenoma or prostate cancer.

There is a chronic asymptomatic form of this disease, when the patient has no complaints, but there is an increase in the amount of purulent elements (leukocytes) in the prostate secretion.

Complications

Without proper therapy, the inflammatory process can lead to a purulent combination of prostate tissue. Moreover, inflammation can spread to nearby organs: seminal tubercles, Cooper's glands, seminal vesicles, urethra. Therefore, the following complications may occur:

  • prostate abscess
  • Sclerosis / fibrosis of the prostate (functioning tissue of the gland is replaced by connective tissue)
  • prostate cyst
  • prostate stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Colliculitis (inflammation of the seminal tubercles)
  • Epididymoorchitis (inflammation of the testis and its appendages)
  • Posterior urethritis
  • Impotence / impotence
  • Ejaculatory disorders
  • Infertility
  • Prostate adenoma
  • Prostate cancer

symptoms

Different forms of prostatitis have their own characteristics of course and severity of symptoms. In general, prostatitis is characterized by the following manifestations:

  • Pain in the groin, lower back, perineum (may radiate along the spermatic cord).
  • Pain increases with defecation, digital rectal examination.
  • Urodynamic disturbances (frequent urination, urinary retention, difficulty urinating, weak flow, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary secretion of prostate juice, especially in the morning and during defecation).
  • Sexual dysfunction (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • Increase in temperature to 39-40 degrees
  • Acute urinary retention
  • General poisoning
  • Leukocyturia, protein and mucus in the urine
  • Blood in urine and semen
  • Leukocytosis in prostatic secretions
  • Hypoechogenicity and gland enlargement, increased blood flow according to ultrasound

Symptoms of chronic prostatitis

  • Body temperature is usually not higher than 37C
  • The sensation of pain becomes dull and smooth
  • Discharge from the urethra during defecation
  • Urinary disorders
  • Decreased libido
  • erectile dysfunction
  • Ejaculatory disorders (premature or delayed ejaculation)

The reasons

The main reason for the development of prostatitis is infection and stagnation of prostate secretions. The following factors contribute to the appearance of prostatitis:

  • Infections and opportunistic flora with weak immunity
  • Hypodynamia
  • "Sedentary work
  • Prolonged sexual abstinence
  • Coitus interruptus (with delayed ejaculation)
  • Excessive sexual activity leads to thinning of the gland
  • Alcohol abuse
  • Decreased local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune diseases)
  • Pelvic organ injury
  • Manipulation of the prostate and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc. )
  • Chronic diarrhea or constipation

Diagnostics

To detect prostatitis, many methods are used, which can be divided into 3 groups: digital rectal examination, laboratory tests and instrumental methods.

Digital rectal examinationcarried out by a urologist-andrologist after a conversation with the patient. This method allows you to evaluate the size, shape and some structural features of the prostate gland. If the size of the prostate is enlarged, and the procedure itself is painful for the patient, the doctor may diagnose prostatitis first.

If the case is not acute, the doctor can perform a prostate massage during the examination to obtain prostate secretion, a study that is an important link in the diagnosis of prostatitis. If there is a suspicion of acute bacterial prostatitis, prostate massage is contraindicated: such manipulations can cause the spread of pathogens and blood poisoning.

To clarify the diagnosis, the patient will be asked to undergoinstrumental research, such as:

  • transrectal ultrasound examination of the prostate and pelvic organs (reveals structural features, the presence of inflammation and purulent foci, stones, cysts and other neoplasms);
  • dopplerography (characteristics of blood flow in the gland);
  • uroflowmetry (determination of the speed and time of urination);
  • magnetic resonance imaging of the pelvic organs (a very informative and safe study that allows differential diagnosis with other diseases).

If necessary, diagnostics of nearby organs of the genitourinary system are carried out: ureteroscopy, urethrography and urethrocystography.

Laboratory researchis an important component in the diagnosis of prostatitis:

  • Urinalysis (before and after prostate massage)
  • General blood analysis
  • Blood test for inflammatory acute phase proteins (C-reactive protein, etc. )
  • Microscopic examination of prostate secretions after finger massage
  • Microscopic examination of scrapings from the urethra
  • Spermogram (sperm cytology and biochemistry)
  • Culture of urine, prostate secretions and semen
  • Determination of prostate-specific antigen (PSA)
  • Prostate puncture biopsy and histological examination of glandular tissue

The last two studies are necessary to rule out prostate cancer or adenoma.

Modern ones have a very good, very informative diagnostic base. Urologists have extensive experience in diagnosing and successfully treating various forms of prostatitis, and the status of a multidisciplinary clinic allows you to use the services of relevant specialists. The medical center has developed a research package that includes all the necessary diagnostics at a very attractive price.

Treatment

Treatment of prostatitis is not an easy task. It requires a thoughtful and integrated approach. The treatment protocol for this disease includes drug therapy and physiotherapy, in some cases surgery is required.

Medical therapy

It involves the use of the following drugs:

  • Antibiotics (after determining sensitivity to them)
  • Antiseptic (local)
  • Vascular preparation (increased microcirculation in the prostate)
  • Nonsteroidal anti-inflammatory drugs
  • Alpha-1-adrenergic blockers (disrupt urination)
  • Enzyme preparation (thins prostate secretions, stimulates the immune system, relieves inflammation)
  • Immunomodulators
  • Antidepressant

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulse exposure)
  • Vibro massage
  • Laser therapy with a rectal sensor (for chronic prostatitis)

In chronic prostatitis, prostate massage can be used as a treatment procedure. In the acute stage of the disease, this manipulation is not carried out to avoid the spread of infection and sepsis.

Surgical treatment

Surgery for prostatitis is rarely performed. Such a need arises in the presence of severe pus on the prostate tissue, the absence of positive dynamics for drug treatment and pathological enlargement of the prostate gland that obstructs the urethra.

Prediction

With early diagnosis and adequate treatment, acute prostatitis can be overcome. However, quite often chronization of the process occurs even with correct and timely therapy.

With improper treatment and non-compliance with treatment conditions (this is several months), the disease, as a rule, takes a chronic course. Chronic prostatitis greatly affects a man's quality of life, because not only urination, but also sexual function suffers. In 30% of cases, erectile dysfunction, loss of orgasmic sharpness, problems with ejaculation, and infertility are observed. It is impossible to cure chronic prostatitis, but with the right approach, you can achieve a stable remission.

Benefits of going to a professional clinic

  • Successful treatment for various forms of prostatitis
  • Experienced urologist-andrologist with the highest qualifications
  • Multidisciplinary, allowing to involve experts in related fields in the treatment
  • High-precision modern diagnostic and treatment equipment
  • Own European class clinical diagnostic laboratory
  • A comfortable and high-tech hospital
  • A package of urological diagnostic services at an attractive price

Prevention of prostatitis

  • Choose safe sex to avoid sexually transmitted infections (STIs)
  • Support the immune system (vitamins, healthy diet, prevention of dysbacteriosis, reasonable antibiotic therapy, etc. )
  • Avoid hypothermia
  • Live an active lifestyle
  • Have sex regularly, if possible, with one partner (to avoid prostate congestion and STIs)
  • Avoid coitus interruptus (this will eliminate sperm stasis)
  • Visit a urologist once a year for preventive purposes and twice a year if you are over 50 or have a history of prostate disease.

Frequently asked questions

How informative is the PSA test in diagnosing prostatitis?

Prostate-specific antigen (PSA) is a marker for prostate cancer. It is known that in some cases prostate cancer has a clinical picture similar to the manifestations of prostatitis. Therefore, the PSA test is used for the differential diagnosis between these two diseases. However, don't bet on PSA. This antigen also increases with prostate adenoma - a benign growth of glandular tissue. With prostatitis, PSA levels can also rise during periods of active inflammation. In the remission phase, it decreases. Therefore, PSA cannot be used as unconditional proof of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

Prostate capillaries have a special structure that creates a hematoprostatic barrier. This makes it difficult for some antibiotics to penetrate the glandular tissue. In addition, microorganisms tend to form biofilms that can protect them from the action of antibacterial agents. Therefore, modern protocols for the treatment of prostatitis necessarily include proteolytic enzymes that can destroy the biofilm. Bacteria become vulnerable and antibiotics work more effectively. Chronic prostatitis is the most stubborn to treat, its main feature is the variety of microflora in the plant. In about 50% of cases, Enterococcus faecalis is sown, resistant to all aminoglycosides and cephalosporins. This narrows the list of effective antimicrobial agents, which also complicates treatment.